Table 2 Knowledge of Concussion

What is the definition of concussion?

Select the best answer.

A. Loss of consciousness for < 5 min after an impact to the head

B. A complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces

C. A structural brain injury caused by mild traumatic force that transiently decreases cerebral blood flow

D. I don’t know

86

94

0.091

Is a concussion a brain injury?

Select the best answer.

A. No, as there is no abnormality seen on standard structural neuroimaging

B. No, as symptoms are only psychological in nature

C. Yes, as there is a function al disturbance that cannot be seen on standard neuroimaging

D. Yes, as there is structural abnormality seen on standard neuroimaging

E. I don’t know

85

88

0.328

Which one of the following is true?

A. A period of unconsciousness is necessary for the diagnosis of a concussion

B. Over 2/3 of all concussions involve loss of consciousness (LOC)

C. 1/3 to 2/3 of all concussions involve loss of consciousness (LOC)

D. Less than 1/3 of all concussions involve loss of consciousness (LOC)

E. I don’t know

53

67

0.071

Which of the following is a sign or symptom of a concussion?

Select all that apply.

A. Headache

A. 100

A. 98.6

A. 0.473^a

B. Hemiparesis

B. 12.8

B. 8.6

B. 0.406

C. Dizziness

C. 94.9

C. 92.9

C. 0.736^a

D. Confusion

D. 100

D. 94.3

D. 0.048^a*

E. Fixed dilated pupil

E. 21.8

E. 11.4

E. 0.093

F. Nausea and/or vomiting

F. 93.6

F. 85.7

F. 0.113

G. Vertigo

G. 55.1

G. 44.3

G. 0.188

H. Amnesia

H. 88.5

H. 94.3

H. 0.211

I. Tinnitus

I. 59

I. 48.6

I. 0.205

J. Emotional or personality changes

J. 79.5

J. 87.1

J. 0.215

K. Papilledema

K. 11.5

K. 7.1

K. 0.362

L. Intention tremor

L. 5.1

L. 4.3

L. 1.000^a

M. Fatigue

M. 80.8

M. 87.1

M. 0.294

N. Temporary loss of consciousness

N. 97.4

N. 94.3

N. 0.422^a

O. Prolonged coma

O. 11.5

O. 14.3

O. 0.618

How many symptoms of a concussion are required to diagnose a concussion?

A. One or more symptoms

B. Three or more symptoms

C. Five or more symptoms

D. I don’t know

26

40

0.062

Which of the following is true regarding the mechanism of concussion?

A. Direct physical contact to the head is necessary to sustain a concussion

B. Localized damage to the brainstem is the cause of a concussion

C. Localized damage to the prefrontal cortex is the cause of a concussion

D. Localized damage to the hippocampus is the cause of a concussion

E. A whiplash effect to the brain caused by an impact to any part of the body may cause a concussion

90

70

0.002^*

What is the appropriate management of concussion?

Select all that apply.

A. Every concussed individual should see a physician

A. 76.9

A. 80

A. 0.650

B. A concussed player cannot return to play in the same game or practice if examined by a physician

B. 60.3

B. 41.4

B. 0.835

C. A stepwise increase in exercise and activity if symptomatic

C. 67.9

C. 77.1

C. 0.212

D. Physical rest is always recommended after a concussion

D. 93.6

D. 84.3

D. 0.069

E. Mental rest is always recommended after a concussion

E. 92.3

E. 87.1

E. 0.299

F. Signs and symptoms should be monitored for increasing severity

F. 92.3

F. 91.4

F. 0.845

G. Full neurological exam at initial assessment is recommended

G. 50

G. 82.9

G. < 0.001^*

H. The standard mini mental status exam at initial assessment is an adequate cognitive test for concussion

H. 53.8

H. 14.3

H. < 0.001^*

I. MRI of the brain is mandatory

I. 0

I. 1.4

I. 0.473^a

J. CT of the brain is mandatory

J. 7.7

J. 4.3

J. 0.500^a

What are some “red flags” that may predict the potential for more prolonged symptoms and may influence your investigation and management of concussion? Select all that apply

A. Nose bleed

A. 16.7

A. 25.7

A. 0.177

B. Prolonged loss of consciousness

B. 98.7

B. 94.3

B. 0.189^a

C. Number and duration of symptoms

C. 88.5

C. 92.9

C. 0.362

D. Age

D. 93.6

D. 81.4

D. 0.024^*

E. Repeated concussions occurring with progressively less impact force

E. 79.5

E. 85.7

E. 0.229

F. Slower recovery after each successive concussion

F. 85.9

F. 91.4

F. 0.292

G. Repeated concussions over time

G. 92.3

G. 90

G. 0.620

H. Concussions close together in time

H. 88.5

H. 90

H. 0.763

I. Being hit on the left side of the head

I. 2.6

I. 7.1

I. 0.256^a

What are the long-term consequences of repetitive concussive injury?

Select all that apply.

A. Dementia

A. 89.7

A. 65.7

A. < 0.001^*

B. Depression

B. 87.2

B. 91.4

B. 0.406

C. Headaches

C. 85.9

C. 87.1

C. 825

D. Increased risk of hemorrhagic stroke

D. 29.5

D. 28.6

D. 0.902

E. Death or disability with second concussion before recovery from a first concussion

E. 79.5

E. 57.1

E. 0.003^*

F. Increased risk of schizophrenia

F. 20.5

F. 17.1

F. 0.601

G. Prolonged fatigue

G. 59

G. 65.7

G. 0.399

H. Impairment of concentration and memory

H. 85.9

H. 87.1

H. 0.825

I. Parkinsonism

I. 47.4

I. 17.1

I. < 0.001^*

J. Chronic traumatic encephalopathy

J. 73.1

J. 50

J. 0.004^*